Abstract 1553P
Background
Pancreatic ductal adenocarcinoma (PDAC) is among the most common malignancies associated with venous thromboembolism (VTE). However, despite recommendations basing on Khorana score commonly known to predict the risk of VTE, thromboprophylaxis has not been prescribed routinely in clinical practice, especially in patients with advanced PDAC.
Methods
Medical charts of patients consecutively treated for advanced PDAC from 2010 to 2019 without thromboprophylaxis were retrospectively reviewed. The cumulative incidence of VTE was estimated using Kaplan-Meier method. Factors associated with VTE were identified using a multivariate Cox’s proportional hazard model with stepwise selection process. Similar analyses were performed for survivals. Early VTE was defined as VTE occurring within the third months from PDAC diagnosis.
Results
A total of 155 patients were included (median age: 68 years; males: 56.1%; performance status 0-1: 85.8%) with metastatic (70.3%) or locally advanced disease (29.7%). At baseline, Khorana score was high (≥3) for the vast majority of cases (94.3%). The cumulative incidences of VTE were 12.2% (95% CI: 6.7-17.3) at 3 months, 20.5% (95%CI: 13.5 - 26.9) at 6 months and 30.1% (95% CI: 21.2-37.9) at 12 months. Independent factors associated with VTE occurrence were age ≥80 years (HR=2.67; 95%CI: 1.06-6.71; P=0.04), body mass index (BMI)>30kg/m2 (HR=2.45; 95%CI: 1.02-5.86; P=0.04), and CRP>150mg/L (HR=8.63; 95%CI: 2.45-30.40; P<0.001). Khorana score≥4 trended to be associated with VTE risk (HR=1.86; 95%CI: 0.91-3.80; P=0.09). Early VTE was associated with shorter progression-free survival (3.5 months vs. 7.1 months; HR=2.35; 95%CI: 1.38-4; P=0.001) and shorter overall survival (5.1 months vs. 15.3 months; HR=2.92; 95%CI: 1.63-5.23; P<0.001) compared to the remnant patients, independently of PS, presence of metastases and chemotherapy regimen. The median time-to-death from the date of VTE was 5.8 months (95%CI: 2.9-8.4 months).
Conclusions
this study confirmed the high incidence of VTE in patients with PDAC and its strong prognostic value. Age≥80 years, BMI>30kg/m2 and CRP>150mg/L should be taken into account additionally to the Khorana score.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
N. Williet: Advisory/Consultancy: Servier; Advisory/Consultancy: Sanofi. All other authors have declared no conflicts of interest.